中醫藥治療男性性功能障礙焦慮和抑鬱的療效：系統綜述與薈萃分析

Efficacy of Chinese herbal medicine in the treatment of anxiety and depression in male sexual dysfunction: a systematic review and meta-analysis

——《性醫學》第13卷第3期，2025年7月——

<Sexual Medicine> Volume 13, Issue 3, July 2025

【摘要】背景：男性性功能障礙 (MSD)，包括勃起功能障礙 (ED) 和早泄 (PE)，其發病率與年齡相關，影響50%的40歲以上男性。除生理表現外，伴有焦慮和抑鬱的MSD還會對社會心理產生深遠的影響。越來越多的證據表明，中草藥 (CHM) 可能具有治療此類臨床交叉疾病的潛力。目的：通過全面的系統綜述和薈萃分析，系統地評估中草藥對緩解 MSD 患者焦慮和抑鬱的療效。方法：本研究系統地檢索了四個中文數據庫（中國知網、萬方數據庫、中國生物醫學數據庫和維普數據庫）以及四個國際數據庫（PubMed、Web of Science、EMBASE 和 Cochrane Library）。納入了探討中草藥干預MSD伴有焦慮和抑鬱的隨機對照試驗 (RCT)。臨床結果：主要結果集中於焦慮和抑鬱症狀的變化，次要結果涵蓋男性性功能的整體改善。結果：通過整合來自12項RCT、涉及1050名參與者的數據，我們的研究結果首次提供了強有力的證據，表明中藥（CHM）可顯著緩解MSD患者的焦慮和抑鬱，同時改善MSD的核心症狀，例如早泄（PE）和勃起功能障礙（ED）。值得注意的是，CHM製劑在改善兩種心理量表方面均表現出優於 SSRI 的療效，包括焦慮自評量表 [MD=-9.11, 95% CI (-11.53, -6.70), P<.05]、抑鬱自評量表 [MD=-9.85, 95% CI (-14.07, -5.63), P<.05]、漢密爾頓抑鬱量表 (HAMD) [MD=-5.30, 95% CI (-11.61, 1.01), P>.05] 和漢密爾頓焦慮量表 [MD=-3.89, 95% CI (-4.52,-3.27), P<.05]，以及MSD特定指標，例如國際勃起功能指數-5 [MD=3.26, 95% CI (1.98, 4.53), P< .05] 和陰道內射精潛伏期 [MD = 1.60, 95% CI (0.82, 2.37), P< .05]。值得注意的是，在我們分析中，HAMD評分缺乏統計學意義，這可能是由於PE和ED人群的治療反應存在差異。臨床意義：本研究為解決傳統治療中分離身心症狀的局限性提供了循證支持，進一步證實了其在整合醫學模式下的應用價值，並為設計個性化患者治療方案探索了新的研究途徑。優勢與局限性：本研究首次進行了系統評價，以評估傳統中藥在緩解MSD患者焦慮和抑鬱症狀的同時改善性功能指標的綜合療效。有限的研究數量是其最大的局限性。結論：我們的研究結果首次提供了強有力的證據，表明中草藥能夠顯著緩解MSD患者的焦慮和抑鬱情緒，同時改善MSD的核心症狀，例如早泄和勃起功能障礙。

【關鍵詞】男性性功能障礙，中草藥，焦慮，抑鬱，系統評價，性心理健康

[Abstract] Background: Male Sexual Dysfunction (MSD), comprising erectile dysfunction (ED) and premature ejaculation (PE), exhibits an age-related prevalence affecting 50% of males beyond their fourth decade. Beyond physiological manifestations, MSD with comorbid anxiety and depression exerts profound psychosocial impacts. Emerging evidence suggests Chinese Herbal Medicine (CHM) may offer therapeutic potential for addressing this clinical intersection. Aim: To systematically assess the efficacy of CHM on alleviating anxiety and depression in patients with MSD via a comprehensive systematic review and meta-analysis. Methods: This study systematically searched four Chinese databases (China National Knowledge Infrastructure, Wanfang Database, China Biomedical Database, and VIP Database) and four international databases (PubMed, Web of Science, EMBASE, and Cochrane Library). Randomized controlled trials (RCTs) investigating CHM interventions for MSD with comorbid anxiety and depression were identified. Outcomes: The primary outcome focused on changes in symptoms of anxiety and depression, while secondary outcomes encompassed overall male sexual function improvement. Results: By synthesizing data from 12 RCTs involving 1050 participants, our findings provide the first robust evidence that CHM significantly alleviates anxiety and depression in MSD, while concurrently improving core symptoms of MSD, such as PE and ED. Notably, CHM formulations demonstrated superior efficacy over SSRIs in improving both psychological scales, including Self-Rating Anxiety Scale [MD = -9.11, 95% CI (-11.53, -6.70), P < .05], Self-Rating Depression Scale [MD = -9.85, 95% CI (-14.07, -5.63), P < .05], the Hamilton Depression Rating Scale (HAMD) [MD = -5.30, 95% CI (-11.61, 1.01), P > .05], and the Hamilton Anxiety Rating Scale [MD = -3.89, 95% CI (-4.52,-3.27), P < .05], as well as MSD-specific metrics, such as International Index of Erectile Function-5 [MD = 3.26, 95% CI (1.98, 4.53), P < .05] and intravaginal ejaculation latency time [MD = 1.60, 95% CI (0.82, 2.37), P < .05]. Importantly, the lack of statistical significance in HAMD scores in our analysis may be attributed to the differences in treatment responses between the PE and ED populations. Clinical Implications: It provides evidence-based support to address the limitations of separating physical and mental symptoms in traditional treatment, further substantiates its application value within the integrated medical model, and explores new research avenues for designing personalized treatment plans for patients. Strengths and Limitations: A first-of-its-kind systematic evaluation was conducted to assess the comprehensive efficacy of traditional CHM in alleviating anxiety and depression symptoms while improving sexual function indicators among patients with MSD. The limited number of studies constitutes the most significant limitation. Conclusions: Our findings provide the first robust evidence that CHM significantly alleviates anxiety and depression in MSD patients, while concurrently improving core MSD symptoms, such as PE and ED.

[Key words] male sexual dysfunction, Chinese herbal medicine, anxiety, depression, systematic review, psychosexual health

論文原文：Zhaozhan Xie, Jinxian Lu, Xuecheng Zhang, Hongling Jia, Yongchen Zhang (2025). Efficacy of Chinese herbal medicine in the treatment of anxiety and depression in male sexual dysfunction: a systematic review and meta-analysis. Sexual Medicine, Volume 13, Issue 3, July 2025.

https://doi.org/10.1093/sexmed/qfaf048

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